6 Business Lessons To Learn From Heroin Dealers

6 Business Lessons To Learn From Heroin Dealers
6 Business Lessons To Learn From Heroin Dealers

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There are business lessons to be learned everywhere, and yes, even from heroin drug dealers.

Unfortunately, heroin dealers know how to do business. Pharmacy owners can learn valuable lessons from these illegal business ventures and can easily implement similar techniques to improve their legal pharmacy businesses.

I recently finished reading the book Dreamland by Sam Quinones. Dreamland is a deep dive into all the factors that came together to create the perfect storm for massive addiction in our society. The book covers everything from changes in how medical professionals treat acute and chronic pain to the arrival of the “Xalisco Boys” from Mexico. It was mind-blowing excellent and tragic.

The Xalisco Boys

The Xalisco Boys were responsible for bringing cheap, black tar heroin into the United States from Mexico. Black tar heroin could be smoked or injected and was purer and cheaper than other types. Although the drug’s properties made it enticing, what took our country and our neighbors by storm was how the Xalisco Boys distributed it.

Rather than the typical highly violent gang structure of other drug cartels, the Boys quietly and softly distributed their heroin. Their cells ran like mini businesses, much like a pizza delivery model. While their black tar heroin business sells a terrible product that ruins lives and kills people, their business method was beautifully and tragically successful. The Xalisco Boys relied on proven business strategies to grow and spot-on customer service to keep their customers loyal. All business owners could do better by implementing their practices (minus the deadly heroin, of course).

Lessons In Business

Here are the six business lessons you can take from the Xalisco Boys and implement into your pharmacy:

  1. Customer Recovery
  2. Referral Program
  3. Mistake Make-up
  4. Surveys/Call Back Program
  5. Customer Appreciation
  6. Empower Your Employees
Business Lesson #1 Customer Recovery

Patient attrition is normal; every pharmacy experiences it. That doesn’t mean that you just let it happen. You can implement an outreach program to identify these patients and then commit to bringing them back to your pharmacy. The Xalisco Boys knew their customers’ buying habits. When a customer missed their regular buy cycle, they would actively call the customer and ask why they were late, or they would visit the customer in person if phone calls were unsuccessful. What do you do in your pharmacy? Many PMS systems have a refill due or late refill report. You can implement this by having an employee call each patient and ask why they missed their fill.

If a customer of the Xalisco Boys mentioned he/she was trying to quit or use less, their response was yes, of course, you should do that. Then, The Boys follow up with, to thank you for your past business, I will give you a free balloon (of heroin). This outreach made the customer feel appreciated and often brought them back into the dark world of using. You can imitate this to get the same outcome to have your past patients feel missed and honored, and perhaps give you another try.

When a patient transfers out, the owner or the pharmacist should call to speak with each patient. In this instance, it shouldn’t be a technician or clerk, in my opinion. During this call, it is vital to discover what went wrong or prompted the patient to leave, but it is also important to thank them for their past business. Follow up each call with a hand-written thank you card and possibly a coupon to your pharmacy for a future visit. To go even further, do this again 90 days after their transfer out as well.

Business Lesson #2 Referral Program

I love referral programs. Effective programs can turn all your patients into your very own marketing army. When you create a culture of serving patients well and properly encouraging your patients to talk about you, it becomes almost magical. Each of your patients has a sphere of influence. Having both a superior patient experience and a referral program allows you to tap into their sphere.

The Xalisco Boys knew this too. They were able to grow because of referrals. They would leverage patients who knew where the local methadone clinics were and freely bring people into the network to score some free dope. Referral rewards always went to their current customer, a big mantra of mine for almost two decades. It was word-of-mouth marketing at its finest. No tracking or fussy cards were necessary; the new person simply stated who sent them. The Boys would then give a free balloon to the person who sent them.

Here are the tenets of a good referral program:

  • Ensure you deserve a referral first
  • Make it easy, no cards or codes
  • Reward your current customers, a $20 minimum
  • Wow the new customer
Business Lesson #3 Mistake Make-Up

Many years ago, when running my first pharmacy, my business coach (hey Patti!) gave me a book that caused a breakthrough for me, A Complaint Is A Gift. Ever since then, I have looked at complaints in a new light. I want complaints because I genuinely want to get better. No business, even your pharmacy, is perfect and will never garner a customer complaint. An important thing to remember is this; all complaints are valid regardless if they are true or not. It is real to the patient, and that is all that matters.

How you recover from a patient complaint can make or break your business. For the Xalisco Boys, if a customer complained a driver was late, they promised an extra balloon next time, and they didn’t forget. If a customer called and said a batch was bad, a driver delivered a new set right away. The lesson here is to go above and beyond to fix the problem immediately. Don’t look for ways to say no; instead, look for ways to say yes.

Now in the pharmacy world, we have rules and laws to follow that, obviously, heroin dealers don’t. If you can’t refund a copay, give the patient a gas card. When an angry patient is out of refills on their controlled prescription, and their doctor is out for the weekend, call the closest urgent care to see the wait time. Do everything you legally can.

Business Lesson #4 Surveys/Call Back Program

What type of drug dealers call and check up on their customers? The Xalisco Boys did, and you should too. When they had a new customer buy for the first time, the driver would call to ask the customer how their experience was. Even established customers received calls to see how they were doing. If heroin dealers can do it, we independent pharmacy owners can too.

Clerks, drivers, and technicians can perform these calls. Print a list of new patients from your PMS and have a call completed to the patient within 72 hours. If you want to go above and beyond, you can choose to do a call and a thank you card. This simple gesture can be the start of building a strong patient relationship. You don’t have to limit yourself to new patients. Expand your call-back program to patients on antibiotics, who received a new prescription, or even randomly picked patients.

You never want to assume the type of experience your patients are having with your pharmacy. You must ask. The best way to do this is with patient surveys. There are many types available, from manual paper forms to Happy or Not systems. During a pivotable time in my first pharmacy, I conducted a mass customer survey. I learned that my patients wanted different business hours, what products they wanted me to carry, and the services they loved. The Xalisco Boys used surveys to determine which areas to grow into and how to bring more value since drug dealing is a competitive business. We can use surveys to serve our patients better too.

Business Lesson #5 Customer Appreciation

All pharmacy owners appreciate your customers and patients (well 99% of them!). Do you make it obvious? Do they regularly feel appreciated? Our relationship with our customers can sometimes get stale, just as with our significant others. Keep the spark alive. You can do this in several ways. Throw a party (post-COVID), celebrate patient birthdays with delivered balloons, thank you cards, and personal phone calls just to say thank you and we appreciate you. Most of all don’t make it subtle. It’s ok to make grand overtures.

The Xalisco Boys would often surprise their loyal customers with a random discount or free goods. Often the only English the drivers could speak was customer appreciation language. They essentially had an unspoken customer rewards program. They did this to make sure customers didn’t entertain by buying from someone else. To ensure your customers don’t look at competitors either, make sure they feel appreciated.

For tips on how to compete against Amazon Pharmacy read part 1 HERE.

Business Lesson #6 Empower Your Employees

A real advantage the Xalisco Boys had over the traditional cartels was their command structure. They didn’t have a kingpin that made all the decisions and needed to insert themselves in every situation. Their drivers were empowered to make it right and to make decisions in the moment. If you feel exhausted and think your pharmacy will fall apart if you ever step away, this could be your exact problem. Everyone is relying on you for every decision.

It is impossible to involve yourself in every transaction of every day. You need to empower your employees to make decisions on their own. You might need to start with baby steps, especially if they have been coming to you for everything in the past. An excellent first step is to stop immediately answering them when they ask you a question. Instead, ask them what they think. You now become the coach in this process instead of an encyclopedia of answers. You can set up parameters for your employees to operate. For example, allow them to make refunds up to $50 or apply a discount of up to 20%.


An ER physician recommended this book to me. He told me this book changed his prescribing habits more than anything else. When deciding to read Dreamland, I certainly didn’t intend to turn it into a business book or to glean business lessons from it. Being immersed in the business world just makes one’s brain see things through that lens. Sam Quinones does a beautiful job stitching together the history and causes of the addiction epidemic we are currently experiencing. It was saddening to read as a health care provider and infuriating as a human citizen. It is a must-read in my book.

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